Surgical instrument with stowing knife blade

ABSTRACT

A surgical instrument with a stowing knife blade includes an elongated shaft, an end effector coupled to the shaft and including two opposed jaws, a housing included in one of the jaws, a first member mounted in the housing and movable distally, a knife pivotally coupled with the first member, and a second member. The knife is configured to cut when advanced distally. The first and second members are moved distally at the same rate during a cutting motion of the knife and the second member blocks a rotation of the knife relative to the first member during the cutting motion of the knife. After moving through the first distance, relative movement between the first and second members occurs so as to permit or induce the previously blocked rotation of the knife so that the knife can be stowed.

This application claims the benefit of U.S. Provisional Application No.61/560,225, filed Nov. 15, 2011, the entirety of which is incorporatedby reference herein.

BACKGROUND

Minimally invasive surgical techniques are aimed at reducing the amountof extraneous tissue that is damaged during diagnostic or surgicalprocedures, thereby reducing patient recovery time, discomfort, anddeleterious side effects. As a consequence, the average length of ahospital stay for standard surgery may be shortened significantly usingminimally invasive surgical techniques. Also, patient recovery times,patient discomfort, surgical side effects, and time away from work mayalso be reduced with minimally invasive surgery.

A common form of minimally invasive surgery is endoscopy, and a commonform of endoscopy is laparoscopy, which is minimally invasive inspectionand surgery inside the abdominal cavity. In standard laparoscopicsurgery, a patient's abdomen is insufflated with gas, and cannulasleeves are passed through small (approximately one-half inch or less)incisions to provide entry ports for laparoscopic instruments.

Laparoscopic surgical instruments generally include an endoscope (e.g.,laparoscope) for viewing the surgical field and tools for working at thesurgical site. The working tools are typically similar to those used inconventional (open) surgery, except that the working end or end effectorof each tool is separated from its handle by an extension tube (alsoknown as, e.g., an instrument shaft or a main shaft). The end effectorcan include, for example, a clamp, grasper, scissor, stapler, cauterytool, linear cutter, or needle holder.

To perform surgical procedures, the surgeon passes working tools throughcannula sleeves to an internal surgical site and manipulates them fromoutside the abdomen. The surgeon views the procedure from a monitor thatdisplays an image of the surgical site taken from the endoscope. Similarendoscopic techniques are employed in, for example, arthroscopy,retroperitoneoscopy, pelviscopy, nephroscopy, cystoscopy, cisternoscopy,sinoscopy, hysteroscopy, urethroscopy, and the like.

Minimally invasive telesurgical robotic systems are being developed toincrease a surgeon's dexterity when working on an internal surgicalsite, as well as to allow a surgeon to operate on a patient from aremote location (outside the sterile field). In a telesurgery system,the surgeon is often provided with an image of the surgical site at acontrol console. While viewing a three dimensional image of the surgicalsite on a suitable viewer or display, the surgeon performs the surgicalprocedures on the patient by manipulating master input or controldevices of the control console. Each of the master input devicescontrols the motion of a servo-mechanically actuated/articulatedsurgical instrument. During the surgical procedure, the telesurgicalsystem can provide mechanical actuation and control of a variety ofsurgical instruments or tools having end effectors that perform variousfunctions for the surgeon, for example, holding or driving a needle,grasping a blood vessel, dissecting tissue, or the like, in response tomanipulation of the master input devices.

Manipulation and control of these end effectors is a particularlybeneficial aspect of robotic surgical systems. For this reason, it isdesirable to provide surgical tools that include mechanisms that providethree degrees of rotational movement of an end effector to mimic thenatural action of a surgeon's wrist. Such mechanisms should beappropriately sized for use in a minimally invasive procedure andrelatively simple in design to reduce possible points of failure. Inaddition, such mechanisms should provide an adequate range of motion toallow the end effector to be manipulated in a wide variety of positions.

Surgical clamping and cutting instruments (e.g., non-robotic linearclamping, stapling, and cutting devices, also known as surgicalstaplers; and electrosurgical vessel sealing devices) have been employedin many different surgical procedures. For example, a surgical staplercan be used to resect a cancerous or anomalous tissue from agastro-intestinal tract. Many known surgical clamping and cuttingdevices, including known surgical staplers, have opposing jaws thatclamp tissue and an articulated knife to cut the clamped tissue.

Surgical clamping and cutting instruments are often deployed intorestrictive body cavities (e.g., through a cannula to inside thepelvis). Accordingly, it is desirable for the surgical clamping andcutting instrument to be both compact and maneuverable for best accessto and visibility of the surgical site. Known surgical clamping andcutting instruments, however, may fail to be both compact andmaneuverable. For example, known surgical staplers may lackmaneuverability with respect to multiple degrees of freedom (e.g., Roll,Pitch, and Yaw) and associated desired ranges of motion. Typically,known surgical staplers have a smaller range of Pitch motion thandesirable and no Yaw motion.

Additionally, surgical clamping and cutting instruments can sometimesfail to fully actuate (e.g., due to a hard obstacle blocking the knifepath), potentially leaving a knife blade exposed. In such an event, itis desirable that the knife blade not be in a position that mayrepresent a hazard with respect to removal of the surgical instrumentfrom the surgical site. Known surgical clamping and cutting instruments,however, may fail to avoid the potential knife hazard and at the sametime be compact and maneuverable.

Thus, there is believed to be a need for improved surgical clamping andcutting instruments and related methods. Such surgical clamping andcutting instruments should be compact and maneuverable, and employ aknife that does not represent a hazard with respect to removal of thesurgical instrument from the surgical site when the surgical instrumentfails to fully actuate.

BRIEF SUMMARY

Improved surgical clamping and cutting instruments (e.g., surgicalstaplers, and electrosurgical vessel sealing devices) and relatedmethods are disclosed. Surgical clamping and cutting instrumentsdescribed herein employ a proximal-to-distal knife movement, therebyorienting the knife to reduce the likelihood of unintentionally cuttingtissue while removing the surgical instrument from the surgical site inthe event that the surgical instrument fails to fully actuate. Thesurgical instruments described herein include first and second movingmembers that are moved toward the distal end at the same rate through afirst distance to cut tissue and subsequently move relative to eachother to facilitate stowing of the knife.

Thus, in one aspect, a method of articulating a knife in a surgicalinstrument is disclosed. The surgical instrument has a proximal end anda distal end. The method includes pivotally supporting the knife from afirst member. The knife is configured to cut when the knife is movedtoward the distal end. A rotation of the knife relative to the firstmember is blocked with the second member while moving the first memberand a second member toward the distal end at the same rate. After movingthe first and second members toward the distal end at the same rate,relative movement between the first and second members is generated toaccomplish at least one of permitting rotation of the knife or inducingrotation of the knife.

In many embodiments, a lead screw is used to actuate the first andsecond members. For example, moving the first and second members towardsthe distal end at the same rate can include rotating a lead screw havinga threaded portion operatively coupled with at least one of the firstmember or the second member. Generating relative movement between thefirst and second members can include rotating a lead screw having athreaded portion and a non-threaded portion. The threaded portion can beoperatively coupled with one of the first and second members and thenon-threaded portion can interface with the other of the first andsecond members such that rotation of the lead screw generates therelative motion between the first and second members.

Any suitable relative movement between the first and second members canbe used. For example, generating relative movement between the first andsecond members can include moving the either one of the first member orthe second member toward the distal end while preventing the other oneof the first and second members from moving toward the distal end toreposition the second member relative to the first member to not blockthe rotation of the knife. As another example, generating relativemovement between the first and second members can include moving theeither one of the first member or the second member toward the proximalend while preventing the other one of the first and second members frommoving toward the proximal end to reposition the second member relativeto the first member to not block the rotation of the knife.

In many embodiments, the relative movement between the first and secondmembers induces rotation of the knife relative to the first member. Forexample, the knife can include external gear teeth that mate withexternal gear teeth coupled with the second member so that the relativemovement between the first and second members causes movement of thesecond member gear teeth relative to the knife gear teeth andcorresponding rotation of the knife relative to the first member.

The knife can engage one or more features to selectively cause the knifeto rotate into a desired position. For example, the method can includeengaging the knife with a kick-down feature to cause the knife to rotaterelative to the first member to stow a cutting edge of the knife belowan upper surface of the housing. As another example, the method caninclude engaging the knife with a kick-down feature coupled to thesecond member thereby causing the knife to rotate relative to the firstmember to stow a cutting edge of the knife below the upper surface ofthe housing. As an additional example, the method can include engagingthe knife with a kick-up feature to cause the knife to rotate into acutting position during the movement of the first and second memberstowards the distal end at the same rate.

The method can further include additional acts performed using thesurgical instrument. For example, the method can include deployingstaples during the movement of the first and second members toward thedistal end at the same rate.

In another aspect, a surgical instrument is disclosed. The surgicalinstrument includes an elongated shaft having a shaft distal end and ashaft proximal end, an end effector coupled to the shaft distal end andincluding two opposed jaws, a housing included in one of the jaws, afirst member mounted in the housing and movable toward the housingdistal end, a knife, and a second member. The second member isconfigured to move with the first member toward the housing distal endthrough a first distance. Relative movement between the first and secondmembers occurs after the first and second members move through the firstdistance. The housing includes a housing proximal end, a housing distalend, an upper surface extending between the housing proximal and distalends, a central cavity extending between the housing proximal and distalends, and a longitudinal slot extending through the upper surface. Theknife is pivotally coupled with the first member. The knife has acutting edge configured to cut when the first member is moved toward thehousing distal end. The cutting edge extends above the housing uppersurface for at least a portion of the distal movement of the firstmember. The second member blocks a rotation of the knife relative to thefirst member while moving with the first member at the same rate towardthe housing distal end and at least one of permits rotation of the knifeafter a relative movement between the first and second members orinduces rotation of the knife during a relative movement between thefirst and second members.

In many embodiments, the surgical instrument includes a lead screwcoupled with the housing for rotation relative to the housing. The leadscrew is operatively coupled with at least one of the first member orthe second member to drive the coupled member along at least a portionof the lead screw in response to rotation of the lead screw. Forexample, the lead screw can have a threaded portion and a non-threadedportion disposed distally of the threaded portion. Both the first andsecond members can be driven along the lead screw when the second membermoves with the first member toward the housing distal end at the samerate. To generate the relative movement between the first and secondmembers, one of the first and second members can be interfaced with thenon-threaded portion and the other one of the first and second memberscan be interfaced with the threaded portion.

The surgical instrument can employ any suitable relative movementbetween the first and second members. For example, the first member orthe second member can move toward the housing distal end when the secondmember moves relative to the first member. As another example, the firstmember or the second member can move toward the housing proximal endwhen the second member moves relative to the first member.

In many embodiments of the surgical instrument, the relative movementbetween the first and second members induces rotation of the kniferelative to the first member. For example, the knife can include gearteeth that mate with gear teeth coupled with the second member so thatthe relative movement between the first and second members causesmovement of the second member gear teeth relative to the knife gearteeth and corresponding rotation of the knife relative to the firstmember.

In many embodiments of the surgical instrument, the second member movesalong with the first member until prevented from doing so. For example,the second member can be prevented from moving toward the housing distalend during a movement of the first member toward the housing distal endto reposition the second member to not block the rotation of the knife.In many embodiments, the second member is slidably mounted to the firstmember to move with the first member along the first distance and to notmove toward the distal end during a movement of the first member towardthe distal end.

The surgical instrument can include one or more features to selectivelyrotate the knife into a desired position. For example, the surgicalinstrument can include a kick-down feature coupled with the housing tocause the knife to rotate relative to the first member to stow thecutting edge of the knife below an upper surface of the housing. Asanother example, the surgical instrument can include a kick-down featurecoupled to the second member to cause the knife to rotate relative tothe first member to stow the cutting edge of the knife below an uppersurface of the housing during the relative motion between the first andsecond members. As an additional example, the surgical instrument caninclude a kick-up feature coupled with the housing to cause the knife torotate into a cutting position during the movement of the first andsecond members towards the distal end at the same rate.

The surgical instrument can include additional features providingadditional functionality. For example, the housing can include aplurality of staple openings extending between the upper surface and thecentral cavity. A plurality of staples can be disposed in the stapleopenings, each of the staples being deployed during a movement of thefirst and second members toward the housing distal end at the same rate.

In another aspect, a demountably attachable cartridge of a surgicalinstrument is disclosed. The cartridge includes a housing demountablyattachable to an end effector of the surgical instrument, a first membermounted in the housing and movable toward a distal end of the housing, aknife, and a second member. The second member is operable to move withthe first member toward the distal end through a first distance.Relative movement between the first and second members occurs after thefirst and second members move through the first distance. The housingincludes a proximal end, a distal end, an upper surface extendingbetween the proximal and distal ends, a central cavity extending betweenthe proximal and distal ends, and a longitudinal slot extending throughthe upper surface. The knife is pivotally coupled with the first memberor the second member. The knife has a cutting edge configured to cutwhen moved toward the distal end. The cutting edge extends through thelongitudinal slot for at least a portion of the movement of the firstmember along the lead screw. The second member blocks a rotation of theknife relative to the first member while moving with the first member.The second member at least one of permits rotation of the knife orinduces rotation of the knife after a relative movement between thefirst and second members.

In many embodiments, the cartridge includes a lead screw coupled withthe housing for rotation relative to the housing. The lead screw isoperatively coupled with at least one of the first member or the secondmember to drive the coupled member along at least a portion of the leadscrew in response to rotation of the lead screw. For example, the leadscrew can have a threaded portion and a non-threaded portion disposeddistally of the threaded portion. Both the first and second members canbe driven along the lead screw when the second member moves with thefirst member toward the housing distal end at the same rate. To generatethe relative movement between the first and second members, one of thefirst and second members can be interfaced with the non-threaded portionand the other one of the first and second members can be interfaced withthe threaded portion.

In many embodiments of the cartridge, the lead screw has a threadedportion and a non-threaded portion disposed toward the distal endrelative to the threaded portion. Both the first and second members aredriven along the threaded portion when the second member moves with thefirst member toward the distal end at the same rate. One of the firstand second members can interface with the threaded portion and the otherone of the first and second members can interface with the non-threadedportion to generate the relative movement between the first and secondmembers in response to a rotation of the lead screw.

The cartridge can employ any suitable relative movement between thefirst and second members. For example, the first member or the secondmember can move toward the housing distal end when the second membermoves relative to the first member. As another example, the first memberor the second member can move toward the housing proximal end when thesecond member moves relative to the first member.

In many embodiments of the cartridge, the relative movement between thefirst and second members induces rotation of the knife relative to thefirst member. For example, the knife can include gear teeth that matewith gear teeth coupled with the second member so that the relativemovement between the first and second members causes movement of thesecond member gear teeth relative to the knife gear teeth andcorresponding rotation of the knife relative to the first member.

In many embodiments of the cartridge, the second member moves along withthe first member until prevented from doing so. For example, the secondmember can be prevented from moving toward the distal end during amovement of the first member toward the distal end to reposition thesecond member to not block the rotation of the knife. In manyembodiments, the second member is slidably mounted to the first memberto move with the first member along the first distance and to not movetoward the distal end during a movement of the first member toward thedistal end.

The cartridge can include one or more features to selectively rotate theknife into a desired position. For example, the cartridge can include akick-down feature coupled with the housing to cause the knife to rotaterelative to the first member to stow a cutting edge of the knife belowan upper surface of the housing. As another example, the cartridge caninclude a kick-down feature coupled to the second member to cause theknife to rotate during a relative movement between the first and secondmembers to stow a cutting edge of the knife below the upper surface ofthe housing. As an additional example, the cartridge can include akick-up feature coupled with the housing to cause the knife to rotateinto a cutting position during the movement of the second member withthe first member toward the distal end at the same rate.

The cartridge can include additional features providing additionalfunctionality. For example, the housing can include a plurality ofstaple openings extending between the upper surface and the centralcavity. A plurality of staples can be disposed in the staple openings,each of the staples being deployed during a movement of the first andsecond members toward the distal end at the same rate.

For a fuller understanding of the nature and advantages of the presentinvention, reference should be made to the ensuing detailed descriptionand accompanying drawings. Other aspects, objects and advantages of theinvention will be apparent from the drawings and detailed descriptionthat follows.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a plan view of a minimally invasive robotic surgery systembeing used to perform a surgery, in accordance with many embodiments.

FIG. 2 is a perspective view of a surgeon's control console for arobotic surgery system, in accordance with many embodiments.

FIG. 3 is a perspective view of a robotic surgery system electronicscart, in accordance with many embodiments.

FIG. 4 diagrammatically illustrates a robotic surgery system, inaccordance with many embodiments.

FIG. 5A is a front view of a patient side cart (surgical robot) of arobotic surgery system, in accordance with many embodiments.

FIG. 5B is a front view of a robotic surgery tool, in accordance withmany embodiments.

FIG. 6 is a perspective view of a robotic surgery tool that includes anend effector having opposed clamping jaws, in accordance with manyembodiments.

FIG. 7 is a perspective view of a demountably attachable cartridge of alinear stapling and cutting surgical instrument, in accordance with manyembodiments.

FIG. 8 is a perspective view of the cartridge of FIG. 7 and an attachedstaple retainer, in accordance with many embodiments.

FIG. 9 is a cross-sectional view showing attachment details between thecartridge of FIG. 7 and an end effector assembly, in accordance withmany embodiments.

FIG. 10 is an exploded perspective view illustrating components of thecartridge of the cartridge of FIG. 7.

FIGS. 11A and 11B are perspective views illustrating a printed circuitassembly of the cartridge of FIG. 7.

FIG. 12A shows a distal end of a housing of the cartridge of FIG. 7.

FIG. 12B includes perspective views of a staple pusher of the cartridgeof FIG. 7.

FIG. 13A is a perspective view illustrating knife articulation andstaple deployment related components of the cartridge of FIG. 7.

FIG. 13B is a perspective cross-sectional view further illustratingknife articulation and staple deployment related components of thecartridge of FIG. 7.

FIGS. 14A through 14E are schematic drawings illustrating articulationof a knife in a surgical instrument, in accordance with manyembodiments.

FIG. 15A is a perspective view illustrating knife articulation andstaple deployment related components of a surgical instrument, inaccordance with many embodiments.

FIG. 15B is a perspective cross-sectional view illustrating a lead screwcoupled with the components of FIG. 15A, in accordance with manyembodiments.

FIG. 15C is an exploded perspective view illustrating the components ofFIG. 15A.

FIG. 15D is a plan view of a slidably mounted support element of thecomponents of FIG. 15A.

FIG. 16 is a side view illustrating knife articulation and stapledeployment related components of a surgical instrument, in accordancewith many embodiments.

FIG. 17 is a side view illustrating knife articulation and stapledeployment related components of a surgical instrument, in accordancewith many embodiments.

FIG. 18 lists acts of a method of articulating a cutting blade in asurgical instrument, in accordance with many embodiments.

FIG. 19 lists optional acts of the method of FIG. 18.

DETAILED DESCRIPTION

In the following description, various embodiments of the presentinvention will be described. For purposes of explanation, specificconfigurations and details are set forth in order to provide a thoroughunderstanding of the embodiments. However, it will also be apparent toone skilled in the art that the present invention may be practicedwithout the specific details. Furthermore, well-known features may beomitted or simplified in order not to obscure the embodiment beingdescribed.

Minimally Invasive Robotic Surgery

Referring now to the drawings, in which like reference numeralsrepresent like parts throughout the several views, FIG. 1 is a plan viewillustration of a Minimally Invasive Robotic Surgical (MIRS) system 10,typically used for performing a minimally invasive diagnostic orsurgical procedure on a Patient 12 who is lying down on an Operatingtable 14. The system can include a Surgeon's Console 16 for use by aSurgeon 18 during the procedure. One or more Assistants 20 may alsoparticipate in the procedure. The MIRS system 10 can further include aPatient Side Cart 22 (surgical robot) and an Electronics Cart 24. ThePatient Side Cart 22 can manipulate at least one removably coupled toolassembly 26 (hereinafter simply referred to as a “tool”) through aminimally invasive incision in the body of the Patient 12 while theSurgeon 18 views the surgical site through the Console 16. An image ofthe surgical site can be obtained by an endoscope 28, such as astereoscopic endoscope, which can be manipulated by the Patient SideCart 22 to orient the endoscope 28. The Electronics Cart 24 can be usedto process the images of the surgical site for subsequent display to theSurgeon 18 through the Surgeon's Console 16. The number of surgicaltools 26 used at one time will generally depend on the diagnostic orsurgical procedure and the space constraints within the operating roomamong other factors. If it is necessary to change one or more of thetools 26 being used during a procedure, an Assistant 20 may remove thetool 26 from the Patient Side Cart 22, and replace it with another tool26 from a tray 30 in the operating room.

FIG. 2 is a perspective view of the Surgeon's Console 16. The Surgeon'sConsole 16 includes a left eye display 32 and a right eye display 34 forpresenting the Surgeon 18 with a coordinated stereo view of the surgicalsite that enables depth perception. The Console 16 further includes oneor more input control devices 36, which in turn cause the Patient SideCart 22 (shown in FIG. 1) to manipulate one or more tools. The inputcontrol devices 36 can provide the same degrees of freedom as theirassociated tools 26 (shown in FIG. 1) to provide the Surgeon withtelepresence, or the perception that the input control devices 36 areintegral with the tools 26 so that the Surgeon has a strong sense ofdirectly controlling the tools 26. To this end, position, force, andtactile feedback sensors (not shown) may be employed to transmitposition, force, and tactile sensations from the tools 26 back to theSurgeon's hands through the input control devices 36.

The Surgeon's Console 16 is usually located in the same room as thepatient so that the Surgeon may directly monitor the procedure, bephysically present if necessary, and speak to an Assistant directlyrather than over the telephone or other communication medium. However,the Surgeon can be located in a different room, a completely differentbuilding, or other remote location from the Patient allowing for remotesurgical procedures.

FIG. 3 is a perspective view of the Electronics Cart 24. The ElectronicsCart 24 can be coupled with the endoscope 28 and can include a processorto process captured images for subsequent display, such as to a Surgeonon the Surgeon's Console, or on another suitable display located locallyand/or remotely. For example, where a stereoscopic endoscope is used,the Electronics Cart 24 can process the captured images to present theSurgeon with coordinated stereo images of the surgical site. Suchcoordination can include alignment between the opposing images and caninclude adjusting the stereo working distance of the stereoscopicendoscope. As another example, image processing can include the use ofpreviously determined camera calibration parameters to compensate forimaging errors of the image capture device, such as optical aberrations.

FIG. 4 diagrammatically illustrates a robotic surgery system 50 (such asMIRS system 10 of FIG. 1). As discussed above, a Surgeon's Console 52(such as Surgeon's Console 16 in FIG. 1) can be used by a Surgeon tocontrol a Patient Side Cart (Surgical Robot) 54 (such as Patent SideCart 22 in FIG. 1) during a minimally invasive procedure. The PatientSide Cart 54 can use an imaging device, such as a stereoscopicendoscope, to capture images of the procedure site and output thecaptured images to an Electronics Cart 56 (such as the Electronics Cart24 in FIG. 1). As discussed above, the Electronics Cart 56 can processthe captured images in a variety of ways prior to any subsequentdisplay. For example, the Electronics Cart 56 can overlay the capturedimages with a virtual control interface prior to displaying the combinedimages to the Surgeon via the Surgeon's Console 52. The Patient SideCart 54 can output the captured images for processing outside theElectronics Cart 56. For example, the Patient Side Cart 54 can outputthe captured images to a processor 58, which can be used to process thecaptured images. The images can also be processed by a combination theElectronics Cart 56 and the processor 58, which can be coupled togetherto process the captured images jointly, sequentially, and/orcombinations thereof. One or more separate displays 60 can also becoupled with the processor 58 and/or the Electronics Cart 56 for localand/or remote display of images, such as images of the procedure site,or other related images.

FIGS. 5A and 5B show a Patient Side Cart 22 and a surgical tool 62,respectively. The surgical tool 62 is an example of the surgical tools26. The Patient Side Cart 22 shown provides for the manipulation ofthree surgical tools 26 and an imaging device 28, such as a stereoscopicendoscope used for the capture of images of the site of the procedure.Manipulation is provided by robotic mechanisms having a number ofrobotic joints. The imaging device 28 and the surgical tools 26 can bepositioned and manipulated through incisions in the patient so that akinematic remote center is maintained at the incision to minimize thesize of the incision. Images of the surgical site can include images ofthe distal ends of the surgical tools 26 when they are positioned withinthe field-of-view of the imaging device 28.

Tissue Gripping End Effectors

FIG. 6 shows a surgical tool 70 that includes a proximal chassis 72, aninstrument shaft 74, and a distal end effector 76 having a jaw 78 thatcan be articulated to grip a patient tissue. The proximal chassisincludes input couplers that are configured to interface with and bedriven by corresponding output couplers of the Patient Side Cart 22. Theinput couplers are drivingly coupled with drive shafts that are disposedwithin the instrument shaft 74. The drive shafts are drivingly coupledwith the end effector 76.

Linear Stapling and Cutting Surgical Instruments

FIG. 7 shows a demountably attachable cartridge 100 of a linear staplingand cutting surgical instrument, in accordance with many embodiments.The cartridge 100 is configured to removably attach to a jaw of an endeffector. The cartridge has a proximal end 102 that is attached to thejaw of the end effector and a distal end 104 disposed at a correspondingdistal end of the jaw of the end effector. The cartridge 100 includessix rows of staple openings 106, a longitudinal slot 108, a proximalknife garage 110, a distal knife garage 112, and a rotational input 114.In many embodiments, a staple is disposed in each of the staple openingsfor deployment there from. The longitudinal slot 108 accommodates acutting blade of a knife member (not shown) extending there from as theknife member is moved from the proximal knife garage 110 to the distalknife garage 112. In operation, the staples are deployed starting at thecartridge proximal end 102 and proceeding to the cartridge distal end104. The cutting blade is moved to trail the stapling of the tissue toensure that only fully stapled tissue is cut. FIG. 8 shows the cartridge100 with an attached staple retainer 116, which is removed prior tousing the cartridge 100.

FIG. 9 is a cross-sectional view showing details of the attachment ofthe cartridge 100 to an end effector 118, in accordance with manyembodiments. The end effector 118 includes a lower jaw 120, an upper jaw122, a two degree of freedom wrist 124, a rotationally-driven clampingmechanism 126, and a spring loaded coupling 128. The lower jaw 120 isconfigured to accommodate and support the cartridge 100, as well asposition the cartridge 100 relative to the spring loaded coupling 128.The upper jaw 122 is pivotally coupled with the lower jaw 120 toarticulate relative to the lower jaw 120 to clamp tissue. The upper jaw122 includes staple forming recesses configured and positioned relativeto the staple openings 106 to form the staples into a “B” shape upondeployment of the staples.

The two degree of freedom wrist 124 provides for attachment of the endeffector 118 to an elongated instrument shaft 130 for articulation ofthe end effector 118 about two orthogonal axes relative to theinstrument shaft 130. Details of a suitable two degree of freedom wristthat can be used are disclosed in U.S. application Ser. No. 12/945,748,entitled “SURGICAL TOOL WITH A TWO DEGREE OF FREEDOM WRIST,” filed Nov.12, 2010, the full disclosure of which is hereby incorporated herein byreference.

The rotationally-driven clamping mechanism 126 actuates the upper jaw122 relative to the lower jaw 120 to securely clamp tissue between theupper and lower jaws. The clamping mechanism 126 is rotationally drivenby a first drive shaft 132 disposed internal to the instrument shaft130. Details of a suitable rotationally-driven clamping mechanism thatcan be used are disclosed in U.S. application Ser. No. 12/945,541,entitled “END EFFECTOR WITH REDUNDANT CLOSING MECHANISMS,” filed Nov.12, 2010, the full disclosure of which is hereby incorporated herein byreference.

The spring-loaded coupling 128 rotationally couples the rotational input114 of the cartridge 100 with an extension shaft 136, which is driven bya second drive shaft 138 disposed internal to the instrument shaft 130.The spring-loaded coupling 128 includes a coil spring 140 and a couplingfitting 142. In the embodiment shown, the coupling fitting 142 employs athree-lobe spline receptacle that interfaces with three-sided externalsurfaces of the rotational input 114 and of the extension shaft 136. Thespring-loaded coupling 142 accommodates angular misalignment of thethree-lobe spline that might occur when the cartridge 100 is installedinto the end effector 118. The spring-loaded coupling 142 fully engagesthe three-lobe spline when rotated into angular alignment. Rotation ofthe rotational input 114 is used to translate a drive member of thecartridge 100. The resulting motion of the drive member is used todeploy the staples and to distally advance a knife member to cut theclamped tissue down the center of the rows of deployed staples.

The end effector 118 includes a first universal joint assembly 148 and asecond universal joint assembly 150. The first universal joint assembly148 rotationally couples the clamping mechanism 126 to the first driveshaft 132. The second universal joint assembly 150 rotationally couplesthe extension shaft 136 to the second drive shaft 138. Each of the firstand second universal joint assemblies 148, 150 is configured to transmittorque through a range of angles suitable to the range of Pitch and Yawof the end effector 118 relative to the instrument shaft 130. Details ofa suitable universal joint assembly that can be used are disclosed inU.S. application Ser. No. 12/945,740, entitled “DOUBLE UNIVERSAL JOINT,”filed Nov. 12, 2010, the full disclosure of which is hereby incorporatedherein by reference.

The first and second drive shafts 132, 138 are disposed offset to thecenterline of the instrument shaft 130, which may be independentlyrotated. Details of a suitable drive mechanism that can be used toactuate the first and second drive shafts 132, 138 are disclosed in U.S.application Ser. No. 12/945,461, entitled “MOTOR INTERFACE FOR PARALLELDRIVE SHAFTS WITHIN AN INDEPENDENTLY ROTATING MEMBER,” filed Nov. 12,2010, the full disclosure of which is hereby incorporated herein byreference.

FIG. 10 is an exploded perspective view illustrating components of thecartridge 100. The illustrated components include the retainer 116, 66staples 152, a printed circuit assembly (PCA) spring 154, a PCA 156, acartridge body 158, 22 staple pushers 160, a first drive member 144, asecond drive member 145, a knife 146, a lead screw 134, a thrust washer162, a lead screw nut 164, and a cover 166. The cartridge body 158 hasthe 66 staple openings 106 arranged in 6 rows, with 3 rows of the stapleopenings 106 being disposed on each side of the longitudinal slot 108.The retainer 116 is removably attachable to the cartridge 100 and coversthe staple openings 106 to retain the staples 152 prior to use of thecartridge 100. The staple pushers 160 interface with the staples 152 andslidingly interface with the cartridge body 158. The lead screw 134 hasa threaded portion 135 and a non-threaded portion 137 disposed towardthe distal end 104 relative to the threaded portion 137. Motion of thefirst drive member 144 along the threaded portion 135 of the lead screw134 results in engagement of the staple pushers 160 by distally-facingramp surfaces 176 of the first drive member 144 to drive the staplepushers 160 up relative to the cartridge body 158 to deploy the staples152 as the first drive member 144 moves towards the distal end 104. Theknife 146 is pivotally supported from the first drive member 144. Theknife 146 includes external gear teeth that interface with external gearteeth of the second drive member 145. The cover 166 is attached to thecartridge body 158.

FIGS. 11A and 11B further illustrate the PCA 156 and the PCA spring 154.The PCA spring 154 interfaces with the cartridge body 158 and retainsthe PCA 156. The PCA spring 154 includes PCA spring hooks 172, whichlatch onto the cartridge body 158 to retain the PCA spring 154. When thecartridge 100 is attached to the end effector 118, instrument pins 174of the end effector 118 slide beneath and lift the PCA 156, therebyelectrically connecting the PCA 156 with the instrument pins 174 andallowing for the use of increased associated tolerances. Thisarrangement however is not critical, as long as the instrument pins 174make suitable contact with the PCA 156. Accordingly, in someembodiments, the PCA 156 can be turned on edge such that the shown chipis out of the load path. The PCA 156 can be used to electronically storeidentification, configuration, and/or use information associated withthe cartridge 100.

The cartridge 100 can be assembled using the following assemblysequence. First, with the cartridge body 158 in a “bottom up”orientation, the staple pushers 160 are installed into the stapleopenings 106. Next, the first drive member 144, the knife 145 pivotallysupported from the first drive member 144, the second drive member 145,the thrust washer 162, and the lead screw nut 164 are installed onto thelead screw 134 and the lead screw nut 164 is laser welded flush to theend of the lead screw 134. The resulting lead screw assembly is theninstalled into the cartridge body 158 with the first drive member 144and the second drive member 145 positioned at the proximal end of thelead screw 134 with suitable positioning of the second drive member 145relative to the first drive member 144 to place the knife 145 in asuitable orientation relative to the first drive member 144 to cuttissue as the first drive member 144 is advanced distally and consistentwith stowing of the knife 146 near the end of the travel of the knife145 toward the distal end of the cartridge body 158. The resultingassembly can then be lubricated, for example, by immersing the resultingassembly into a lubricant. Next, the cover 166 is installed onto thecartridge body 158. Next, the assembly is flipped to a “top up”orientation and the PCA 156 is installed. Next, the PCA spring 154 ispushed onto the cartridge body 158 until the PCA spring hooks 172 latch.Next, the staples 152 are installed into the staple openings 106 and theretainer 116 is then installed. Finally, data is installed into the PCA156.

FIG. 12A shows a distal end of the cartridge body 158. FIG. 12B shows atop view and a perspective view of one of the staple pushers 160. Asillustrated, the staple openings 106 and the staple pushers 160 havecomplementary shapes such that each of the staple pushers 160 isaccommodated within one of the staple openings 106 for translationwithin the staple opening 106 in response to being driven by the drivemember 144 as the drive member 144 is translated toward the cartridgedistal end 104.

FIG. 13A shows an assembly 200 of the cartridge 100 that includes thefirst drive member 144, the knife 146 pivotally supported from the firstdrive member 144 (pivot pin not shown), and the second drive member 145.FIG. 13B shows the assembly coupled with the lead screw 134. Each of thefirst drive member 144 and the second drive member 145 include internalthreads that operatively couple with the threaded portion 135 of thelead screw 134 for simultaneous translation along the lead screw 134 inresponse to rotation of the lead screw 134. As the first and seconddrive members 144, 145 translate along the threaded portion 135, thefirst and second drive members 144, 145 maintain fixed relativepositioning thereby blocking rotation of the knife 146 relative to thefirst drive member 144 via the gearing interface between the seconddrive member 145 and the knife 146. Near the end of the articulation ofthe knife 146, the first drive member 144 is driven onto thenon-threaded portion 137 of the lead screw 134. Thereafter, continuedrotation of the lead screw 134 results in continued distal movement ofthe second drive member 145 relative to the cartridge body 158 with nofurther distal movement of the first drive member 144 relative to thecartridge body 158. The resulting relative distal movement of the seconddrive member 145 relative to the first drive member 144 rotates theknife 146 relative to the first drive member 144 to stow the knife 146,for example, into the longitudinal slot 108. The assembly 200 can beconfigured such that a distal surface 202 of the second drive member 145contacts a proximal surface 204 of the first drive member 144 to end therotation of the knife 146 relative to the first drive member 144.Thereafter, continued distal movement of the second drive member 145along the threaded portion 135 can be used to drive the assembly 200distally, for example, into the distal garage 112 of the cartridge 158.

In the embodiment shown, once the first drive member 144 is driven ontothe non-threaded portion 137, continued distal movement of the seconddrive member 145 along the lead screw 134 is used to stow the knife 146.Alternatively, after the first drive member 144 has been driven onto thenon-threaded portion 137 of the lead screw 134, the direction ofrotation of the lead screw 134 can be reversed to move the second drivemember 145 proximally relative to the first drive member 144 therebyrotating the knife 146 relative to the first drive member 144 to stowthe knife into the longitudinal slot 108.

FIGS. 14A through 14E schematically illustrate another approach forarticulating a knife in a surgical instrument 210, in accordance withmany embodiments. The surgical instrument 210 includes a housing 212, alead screw 134, a first drive member 214, a knife 216, a second drivemember 218, a knife kick-up feature 220, and a knife kick-down feature222. The housing 212 includes a proximal end 224, a distal end 226, anupper surface 228 extending between the proximal end 224 and the distalend 226, a proximal knife garage 230, a distal knife garage 232, acentral cavity extending between the proximal end 224 and the distal end226, and a longitudinal slot extending between the upper surface 228 andthe central cavity. The lead screw 134 is mounted in the housing 212 forrotation relative to the housing 212 and extends between the proximalend 224 and the distal end 226 through the central cavity. The leadscrew 134 has a threaded portion 135 and a non-threaded portion 137disposed toward the distal end 226 relative to the threaded portion 135.The first and second drive members 214, 218 have internal threadsconfigured to couple with the threaded portion 135 of the lead screw 134for translation along the threaded portion 135 in response to rotationof the lead screw 134. The knife 216 is pivotally supported from thefirst drive member 214. The knife kick-up feature 220 and the knifekick-down feature 222 are coupled with the housing 212 and have fixedpositions relative to the housing 212.

FIG. 14A illustrates the surgical instrument 210 in a startingconfiguration in which the knife 216 is disposed in the proximal garage230. The knife 216 is shown in a non-cutting orientation relative to thefirst drive member 214 (i.e., rotated relative to a cutting orientationof the knife shown in FIG. 14B). The non-cutting orientation of theknife may enable the use of a shorter housing by reducing the initiallength of the combination of the first drive member 214 and the knife216. A shorter housing provides for a more compact surgical instrument210, thereby enhancing maneuverability of the surgical instrument and/orvisibility within a surgical site. Alternatively, the knife member 216can start in a cutting position.

From the starting configuration illustrated in FIG. 14A, rotation of thelead screw 134 simultaneously drives the first and second drive members214, 218 distally along the lead screw 134. During the initial distalmovement of the first drive member 214, the knife 216 contacts thekick-down feature 220, which causes rotation of the knife 216 relativeto the first drive member 214 into the cutting position illustrated inFIG. 14B. In the cutting position, further rotation of the knife 216relative to the first drive member 214 is blocked by the second drivemember 218.

From the position shown in FIG. 14B, continued rotation of the leadscrew 134 continues to simultaneously drive the first and second drivemembers 214, 218 distally along the lead screw 134 until the first drivemember 214 is driven onto the non-threaded portion 137 of the lead screw134 as illustrated in FIG. 14C. From the position illustrated in FIG.14C, continued rotation of the lead screw 134 continues to drive onlythe second drive member 218 distally along the threaded portion 134 ofthe lead screw 134 to where the second drive member 218 contacts thefirst drive member 214 as illustrated in FIG. 14D. In the positionillustrated in FIG. 14D, the second drive member 218 is no longerpositioned to block rotation of the knife 216 relative to the firstdrive member 214. From the position illustrated in 14D, continuedrotation of the lead screw 134 continues to drive the second drivemember 218 along the threaded portion 135 of the lead screw 134, therebyalso driving the first drive member 214 along the non-threaded portion137 of the lead screw 134. By driving the first drive member 214 alongthe non-threaded portion 137 of the lead screw 134, the knife 216contacts the kick-down feature 222, thereby ensuring that the knife 216rotates down into the longitudinal slot for stowage into the distalknife garage 232 during the continued distal motion of the first andsecond drive members 214, 218 to the position illustrated in FIG. 14E.

FIGS. 15A through 15D illustrate another approach for articulating aknife in a surgical instrument, in accordance with many embodiments. Aknife actuation assembly 240 includes a drive member 242, a knife 244,and a support member 246. The drive member 242 is internally threaded tooperatively couple with a lead screw 134 for translation along the leadscrew 134 in response to rotation of the lead screw 134. The drivemember 242 includes distally facing ramps 248 configured to interfacewith staple pushers to deploy staples as the drive member 242 translatesalong the lead screw 134. The knife 244 is pivotally supported from thedrive member 242 via a pivot pin (not shown). The support member 246includes a central slot 250, a distal portion 252, and a guide pin 254.The support member 246 is slidably mounted in the drive member 242. Thedistal portion 252 of the support member 246 blocks a rotation of theknife 244 relative to the drive member 242 when the support member 246is positioned relative to the drive member 242 as shown in FIGS. 15A and15B.

The knife actuation assembly 240 is configured to maintain theconfiguration shown in FIGS. 15A and 15B from the start of articulationof the knife 244 to near the end of articulation of the knife 244,thereby maintaining the knife 244 in a cutting orientation relative tothe drive member 242. For example, an interference fit between thesupport member 246 and the drive member 242 and/or a retaining provision(e.g., an adhesive, a frangible feature) can be used prevent inadvertentmotion between the support member 246 and the drive member 242.

Near the end of the articulation of the knife 244, the support member246 contacts a portion of the housing that prevents further distalmovement of the support member 246 and does not prevent further distalmovement of the drive member 242. Thereafter, continued rotation of thelead screw 134 produces further distal movement of the drive member 242along the lead screw 134, thereby producing relative movement betweenthe support member 246 and the drive member 242. The relative movementrepositions the support member 246 to reposition the distal portion 252and the central slot 250 of the support member 246 to permit thepreviously blocked rotation of the knife 244 relative to the drivemember 242. Once the support member 246 has been repositioned relativeto the drive member 242 to permit the previously blocked rotation of theknife 244 relative to the drive member 242, continued rotation of thelead screw 134 can be used to further move the drive member 242 distallyalong the lead screw 134 such that the knife 244 contacts a kick-downfeature 256, which ensures rotation of the knife 244 relative to thedrive member 242 to stow the knife 244.

FIG. 16 illustrates another approach for articulating a knife in asurgical instrument, in accordance with many embodiments. A knifeactuation assembly 260 includes a drive member 262, a knife 264, adistal member 266, and a lead screw 134. The drive member 262 and thedistal member 264 are slidably mounted in a housing and are mounted onthe lead screw 134. The drive member 262 includes internal threads 268,which are operatively coupled with the lead screw 134 to move the drivemember 262 along the lead screw 134 in response to rotation of the leadscrew 134. The distal member 266 is not operatively coupled with thelead screw 134. Instead, the distal member 266 is pushed distally alongthe lead screw 134 by the drive member 262. The distal member 266includes distal-facing ramp surfaces 270 configured to engage staplepushers as the distal member 266 is pushed along the lead screw 134 bythe drive member 262. The knife 264 is pivotally supported from thedrive member 262 via a pivot pin 272.

The assembly 260 is configured to orient the knife 264 in a cuttingposition when the drive member 262 pushes the distal member 264 alongthe lead screw and to stow the knife 264 when the drive member 262 ismoved proximally relative to the distal member 264. The distal member264 includes an interface feature 274 that interfaces with the knife 264to rotationally orient the knife 264 relative to the drive member 262.When the drive member 262 is pushing the distal member 264, theinterface feature 272 is positioned to orient the knife 264 in thecutting position and prevent rotation of the knife 264 about the pivotpin 272, thereby maintaining the knife 264 in the cutting position. Theinterface feature 272 also induces rotation of the knife 264 relative tothe drive member 262 when the drive member 262 is moved proximallyrelative to the distal member 266, thereby stowing the knife 264. Inoperation, the lead screw 134 is first rotated to advance the drivemember 262 distally along the lead screw 134 thereby pushing the distalmember 266 along the lead screw 134 to deploy staples and to maintainthe knife 264 in the cutting position. At the end of the distal movementof the assembly 260, the direction of rotation of the lead screw 134 isreversed to retract the drive member 262 proximally relative to thedistal member 266, thereby causing the knife 264 to rotate down into thestowed position via interaction between the interface feature 272 andthe knife 264.

FIG. 17 illustrates another approach for articulating a knife in asurgical instrument, in accordance with many embodiments. A knifeactuation assembly 280 includes a drive member 282, a knife 284, a knifesled 286, and a lead screw 134. The drive member 282 and the knife sled286 are slidably mounted in a housing. The drive member 282 includesinternal threads operatively coupled with the lead screw 134 to move thedrive member 282 along the lead screw 134 in response to rotation of thelead screw 134. The knife sled 286 is drivable distally by the drivemember 282 via contact between the drive member 282 and a drive feature288 of the knife sled 286. The knife 284 is pivotally supported from theknife sled 286 via a pivot pin 290. The angular orientation of the knife284 relative to the knife sled 286 is coupled with the position of thedrive member 282 relative to the knife sled 286 by an interface feature292 of the drive member 282, which interfaces with the knife 284 tocontrol the angular orientation of the knife 284 relative to the knifesled 286. The drive member 282 includes distal-facing ramp surfaces 294configured to engage staple pushers as the drive member 282 movesdistally along the lead screw 134.

The assembly 280 is configured to orient the knife 284 in a cuttingposition when the drive member 282 pushes the knife sled 286 along thelead screw 134 and to stow the knife 284 when the drive member 282 ismoved proximally relative to the knife sled 286. In operation, the leadscrew 134 is first rotated to advance the drive member 282 distallyalong the lead screw 134 thereby pushing the knife sled 286 in thedistal direction and angularly orienting the knife 284 in the cuttingposition. At the end of the distal movement of the assembly 280, thedirection of rotation of the lead screw 134 is reversed to retract thedrive member 282 proximally relative to the knife sled 286, therebycausing the knife 284 to rotate down into the stowed position viainteraction between the interface feature 292 and the knife 284.

Combinations and/or Modifications

The surgical instruments, assemblies, and cartridges disclosed hereincan be modified and/or combined in any suitable fashion. For example,the cartridge 100 described herein can be modified to employ the knifearticulation approach embodied in the surgical instrument 210 describedherein, to employ the knife actuation assembly 240 as described herein,to employ the knife actuation assembly 260 as described herein, or toemploy the knife actuation assembly 280 as described herein. Likewise,the surgical instrument 210 described herein can be modified to employthe knife actuation assembly 200 described herein, to employ the knifeactuation assembly 240 as described herein, to employ the knifeactuation assembly 260 as described herein, or to employ the knifeactuation assembly 280 as described herein. And the surgicalinstruments, assemblies, and cartridges disclosed herein, or resultingfrom the foregoing modifications can be embodied in a detachablymountable cartridge such as cartridge 100 and can be embodied directlyinto a surgical instrument without being detachably mountable to an endeffector of a surgical instrument.

Knife Articulation Methods

FIG. 18 shows acts of a method 300 of articulating a knife in a surgicalinstrument, in accordance with many embodiments. Any suitable surgicalinstrument (e.g., stapling and cutting surgical instruments,electrosurgical vessel sealing devices) can be used to practice themethod 300. For example, the linear stapling and cutting surgicalinstruments, cartridges, and related assemblies described herein can beused to practice the method 300.

In act 302, a knife is pivotally supported from a first member. Theknife is configured to cut when the knife member is moved toward thehousing distal end. In act 304, a rotation of the knife relative to thefirst member is blocked by a second member while moving the first andsecond members toward the distal end at the same rate. In act 306, aftermoving the first and second members toward the distal end at the samerate, the second member is moved relative to the first member toaccomplish at least one of permitting the blocked rotation of the knifeor inducing the blocked rotation of the knife.

FIG. 19 shows optional acts that can be accomplished in the method 300,in accordance with many embodiments. In optional act 308, a lead screwis rotated to move the first and second members distally along the leadscrew. In optional act 310, a lead screw having a threaded portion and anon-threaded portion is rotated to move the second member relative tothe first member. In optional act 312, the knife member is rotatedrelative to the first member in response to the relative movementbetween the first and second members. In optional act 314, one of thefirst and second members is moved toward the distal end while the otherone of the first and second members is prevented from moving toward thedistal end to reposition the second member to not block the rotation ofthe knife. In optional act 316, the knife is engaged with a kick-downfeature to cause the knife to rotate to stow a cutting edge of the knifebelow an upper surface of a housing of the surgical instrument. Inoptional act 318, the knife is engaged with a kick-down feature coupledwith the second member to cause the knife to rotate to stow a cuttingedge of the knife below an upper surface of a housing of the surgicalinstrument. In optional act 320, the knife is engaged with a kick-upfeature to rotate the knife into a cutting position during the movementof the first and second members toward the distal end at the same rate.In optional act 322, staples are deployed during the movement of thefirst and second members toward the distal end at the same rate.

The methods disclosed herein can be employed in any suitableapplication. For example, the methods disclosed herein can be employedin surgical instruments, manual or powered, hand-held or robotic,directly controlled or teleoperated, for open or minimally invasive(single or multi-port) procedures.

Other variations are within the spirit of the present invention. Thus,while the invention is susceptible to various modifications andalternative constructions, certain illustrated embodiments thereof areshown in the drawings and have been described above in detail. It shouldbe understood, however, that there is no intention to limit theinvention to the specific form or forms disclosed, but on the contrary,the intention is to cover all modifications, alternative constructions,and equivalents falling within the spirit and scope of the invention, asdefined in the appended claims.

The term “force” is to be construed as encompassing both force andtorque (especially in the context of the following claims), unlessotherwise indicated herein or clearly contradicted by context. The useof the terms “a” and “an” and “the” and similar referents in the contextof describing the invention (especially in the context of the followingclaims) are to be construed to cover both the singular and the plural,unless otherwise indicated herein or clearly contradicted by context.The terms “comprising,” “having,” “including,” and “containing” are tobe construed as open-ended terms (i.e., meaning “including, but notlimited to,”) unless otherwise noted. The teem “connected” is to beconstrued as partly or wholly contained within, attached to, or joinedtogether, even if there is something intervening. Recitation of rangesof values herein are merely intended to serve as a shorthand method ofreferring individually to each separate value falling within the range,unless otherwise indicated herein, and each separate value isincorporated into the specification as if it were individually recitedherein. All methods described herein can be performed in any suitableorder unless otherwise indicated herein or otherwise clearlycontradicted by context. The use of any and all examples, or exemplarylanguage (e.g., “such as”) provided herein, is intended merely to betterilluminate embodiments of the invention and does not pose a limitationon the scope of the invention unless otherwise claimed. No language inthe specification should be construed as indicating any non-claimedelement as essential to the practice of the invention.

Preferred embodiments of this invention are described herein, includingthe best mode known to the inventors for carrying out the invention.Variations of those preferred embodiments may become apparent to thoseof ordinary skill in the art upon reading the foregoing description. Theinventors expect skilled artisans to employ such variations asappropriate, and the inventors intend for the invention to be practicedotherwise than as specifically described herein. Accordingly, thisinvention includes all modifications and equivalents of the subjectmatter recited in the claims appended hereto as permitted by applicablelaw. Moreover, any combination of the above-described elements in allpossible variations thereof is encompassed by the invention unlessotherwise indicated herein or otherwise clearly contradicted by context.

All references, including publications, patent applications, andpatents, cited herein are hereby incorporated by reference to the sameextent as if each reference were individually and specifically indicatedto be incorporated by reference and were set forth in its entiretyherein.

What is claimed is:
 1. A surgical instrument comprising: an elongatedshaft having a shaft distal end and a shaft proximal end; an endeffector coupled to the shaft distal end and including two opposed jaws;a housing included in one of the jaws; the housing including a housingproximal end, a housing distal end, an upper surface extending betweenthe housing proximal and distal ends, a central cavity extending betweenthe housing proximal and distal ends, and a longitudinal slot extendingthrough the upper surface; a first member mounted in the housing andmovable toward the housing distal end; a second member configured tomove with the first member toward the housing distal end at the samerate through a first distance, relative movement between the first andsecond members occurring after the first and second members move throughthe first distance, the second member blocking a rotation of the kniferelative to the first member while moving with the first member at thesame rate toward the housing distal end and at least one of permittingrotation of the knife after a relative movement between the first andsecond members or inducing rotation of the knife during a relativemovement between the first and second members; and a knife pivotallycoupled with the first member, the knife extending through thelongitudinal slot, the knife having a cutting edge configured to cutwhen the first member is moved toward the housing distal end, thecutting edge extending above the housing upper surface for at least aportion of the distal movement of the first member.
 2. The surgicalinstrument of claim 1, further comprising a lead screw coupled with thehousing for rotation relative to the housing, the lead screw beingoperatively coupled with at least one of the first member or the secondmember to drive the coupled member along at least a portion of the leadscrew in response to rotation of the lead screw.
 3. The surgicalinstrument of claim 2, wherein the lead screw has a threaded portion anda non-threaded portion disposed distally of the threaded portion, boththe first and second members being driven along the lead screw when thesecond member moves with the first member toward the housing distal endat the same rate and one of the first and second members interfacingwith the non-threaded portion and the other one of the first and secondmembers interfacing with the threaded portion to generate the relativemovement between the first and second members.
 4. The surgicalinstrument of claim 1, wherein the first member or the second membermoves toward the housing distal end when the second member movesrelative to the first member.
 5. The surgical instrument of claim 1,wherein the first member or the second member moves toward the housingproximal end when the second member moves relative to the first member.6. The surgical instrument of claim 1, wherein the relative movementbetween the first and second member induces rotation of the kniferelative to the first member.
 7. The surgical instrument of claim 6,wherein the knife includes gear teeth that mate with gear teeth coupledwith the second member so that relative movement between the first andsecond members causes rotation of the knife relative to the firstmember.
 8. The surgical instrument of claim 1, wherein the second memberis slidably mounted to the first member to move with the first memberalong the first distance and to not move toward the distal end during amovement of the first member toward the distal end.
 9. The surgicalinstrument of claim 1, comprising a kick-up feature coupled with thehousing to rotate the knife into a cutting position during the movementof the second member with the first member toward the housing distal endat the same rate.
 10. The surgical instrument of claim 1, wherein thehousing includes a plurality of staple openings extending between theupper surface and the central cavity, the surgical instrument comprisinga plurality of staples disposed in the staple openings, each of thestaples being deployed during a movement of the first and second memberstoward the housing distal end at the same rate.
 11. A demountablyattachable cartridge of a surgical instrument, the cartridge comprising:a housing demountably attachable to an end effector of the surgicalinstrument; the housing including a proximal end, a distal end, an uppersurface extending between the proximal and distal ends, a central cavityextending between the proximal and distal ends, and a longitudinal slotextending through the upper surface; a first member mounted in thehousing and movable toward the distal end; a second member operable tomove with the first member toward the distal end through a firstdistance, relative movement between the first and second membersoccurring after the first and second members move through the firstdistance, the second member blocking a rotation of the knife relative tothe first member while moving with the first member and at least one ofpermitting rotation of the knife after a relative movement between thefirst and second members or inducing rotation of the knife during therelative movement between the first and second members; and a knifepivotally coupled with the first member, the knife having a cutting edgeconfigured to cut when moved toward the distal end, the cutting edgeextending through the longitudinal slot for at least a portion of thedistal movement of the first member.
 12. The cartridge of claim 11,further comprising a lead screw coupled with the housing for rotationrelative to the housing, the lead screw being operatively coupled withat least one of the first member or the second member to drive thecoupled member along at least a portion of the lead screw in response torotation of the lead screw.
 13. The cartridge of claim 12, wherein thelead screw has a threaded portion and a non-threaded portion disposeddistally of the threaded portion, both the first and second membersbeing driven along the lead screw when the second member moves with thefirst member toward the distal end at the same rate and one of the firstand second members interfacing with the non-threaded portion and theother one of the first and second members interfacing with the threadedportion to generate the relative movement between the first and secondmembers in response to a rotation of the lead screw.
 14. The cartridgeof claim 13, wherein the first member or the second member moves towardthe distal end when the second member moves relative to the firstmember.
 15. The cartridge of claim 13, wherein the first member or thesecond member moves toward the proximal end when the second member movesrelative to the first member.
 16. The cartridge of claim 11, wherein therelative movement between the first and second member induces rotationof the knife relative to the first member.
 17. The cartridge of claim16, wherein the knife includes gear teeth that mate with gear teethcoupled with the second member so that relative movement between thefirst and second members causes rotation of the knife relative to thefirst member.
 18. The cartridge of claim 11, wherein the second memberis slidably mounted to the first member to move with the first memberalong the first distance and to not move toward the distal end during amovement of the first member toward the distal end.
 19. The cartridge ofclaim 11, comprising a kickup feature coupled with the housing to rotatethe knife into a cutting position during the movement of the secondmember with the first member toward the distal end at the same rate. 20.The cartridge of claim 11, wherein the housing includes a plurality ofstaple openings extending between the upper surface and the centralcavity, the cartridge comprising a plurality of staples disposed in thestaple openings, each of the staples being deployed during a movement ofthe first and second members toward the distal end at the same rate.